JP2018201907A - Guide tube - Google Patents

Abstract

To provide a guide tube for accurately checking a state in the bile duct.SOLUTION: A guide tube 1 is configured to allow insertion of an endoscope 2 with a camera in the inside thereof. The guide tube 1 is configured to deliver the endoscope 2 toward the inside of the papilla Vater 83a in the duodenum 81. The guide tube 1 includes: a tube body 3 including a bending part 3a at a distal side and having flexibility; and a bending operation part 4 provided at a proximal end of the tube body 3 for bending the bending part 3a. The tube body 3 includes an opening part formed at a distal side of the bend starting portion of the bending part 3a. The guide tube is configured to project the endoscope 2 from the opening part of the tube body 3 that bends the bending part 3a toward the papilla Vater 83a, and deliver the endoscope to the inside of the papilla Vater 83a.SELECTED DRAWING: Figure 1

Description

  The present invention relates to a guide tube used in medical practice, and more particularly to a guide tube for feeding an endoscope into a bile duct from a fatter nipple.

As a method for observing the state of a subject's bile duct, a method of confirming with a X-ray after injecting a contrast medium into the bile duct is known.
For example, in Patent Document 1, after inserting an endoscope to the position of the duodenum in the body, a catheter inserted through the forceps hole of the endoscope is inserted into the bile duct from the papilla and the contrast medium is injected from the catheter A method is disclosed.

  However, according to the method of confirming with X-rays, it may be difficult to distinguish the tumor. There is also known a method for directly imaging the inside of a bile duct with a scope inserted through a forceps hole of an endoscope.

JP 2002-272675 A

  However, the scope inserted through the endoscope in this way is limited in size in the radial direction by the diameter of the forceps hole of the endoscope. For this reason, it was difficult for a scope with a limited size to have a high resolution. If such a scope is provided with a high resolution, it may not be adopted because of high costs due to technical problems. In this case, it is difficult to accurately check the state in the bile duct.

  The present invention has been made in view of the above problems. That is, an object of the present invention is to provide a medical device for enabling accurate confirmation of the state in the bile duct.

  The guide tube of the present invention is a guide tube that can be inserted into an endoscope with a camera, and the guide tube feeds the endoscope into a papilla in the duodenum, A tube main body having a bending portion on the side and having flexibility, and a bending operation portion provided at a proximal end portion of the tube main body to bend the bending portion, the tube main body including the bending An opening is formed on the distal end side of the bending start point of the part, and the endoscope protrudes from the opening of the tube body in which the bent part is bent toward the furter papilla. It is possible to send in.

  The guide tube of the present invention having the above configuration is provided with a bending portion at the distal end portion of the tube main body, and a bending operation portion is provided on the proximal end side of the tube main body, so that the endoscope can be easily fed into the fatter papilla, The state in the bile duct can be confirmed accurately.

It is a figure which shows the state which has confirmed the inside of a bile duct by an endoscope through an endoscope in a guide tube, and is explanatory drawing explaining the whole structure. It is explanatory drawing explaining the bending operation | movement of the bending part of a guide tube. It is a longitudinal cross-sectional view of the front-end | tip part of a guide tube. FIG. 4 is a transverse sectional view of a bent portion of the guide tube, and is a sectional view taken along the line IV-IV in FIG. 3. It is explanatory drawing which shows the inside of a bending operation part typically. FIG. 6 is a view showing the inside of the bending operation section, and is a cross-sectional view taken along the line VI-VI in FIG. 5. It is a perspective view which shows a stopper. FIG. 4 is a transverse sectional view of the guide tube in the vicinity of the balloon, and is a sectional view taken along the line VIII-VIII in FIG. 3. It is a fragmentary sectional view which shows a deaeration prevention valve, a clamp, and a lumen connection part. FIG. 5 is a cross-sectional view taken along the line XX of FIG. 4 showing the inner lumen. It is a perspective view which shows the state which protruded the front-end | tip part of the endoscope from the guide tube. It is a cross-sectional view of the guide tube which concerns on a 1st modification. It is a longitudinal cross-sectional view which shows typically the guide tube which concerns on a 2nd modification.

Hereinafter, embodiments of the guide tube of the present invention will be described with reference to the drawings.
The embodiment described below is merely an example for facilitating the understanding of the present invention, and does not limit the present invention. That is, the shape, dimensions, arrangement, and the like of the members described below can be changed and improved without departing from the spirit of the present invention, and the present invention naturally includes equivalents thereof.
Moreover, in all drawings, the same code | symbol is attached | subjected to the same component, and the overlapping description is abbreviate | omitted suitably. In the following, the distal side of the guide tube is also referred to as the distal end side, and the proximal side is also referred to as the proximal end side.

<About the overall configuration>
The overall configuration including the guide tube 1 according to the present embodiment will be described with reference mainly to FIGS. FIG. 1 is a diagram showing a state in which the endoscope 2 is passed through the guide tube 1 and the inside of the bile duct 83 in the pancreas 82 is confirmed by the endoscope 2, and is an explanatory diagram for explaining the overall configuration. FIG. 2 is an explanatory view for explaining the bending operation of the bending portion 3 a of the guide tube 1, and FIG. 3 is a longitudinal sectional view of the distal end portion of the guide tube 1. 4 is a cross-sectional view of the bent portion 3a of the guide tube 1, and is a cross-sectional view taken along the line IV-IV in FIG.

The guide tube 1 has a function of guiding the endoscope 2. The endoscope 2 is used for confirming the state in the bile duct 83 that has passed through the fatter papilla 83a, and has a configuration in which the distal end portion can be bent by the operation portion 2a. The endoscope 2 is of a size that can be used also for nasal transfusion, and includes a camera 2b and a light 2c at the distal end as will be described later with reference to FIG.
Specifically, the guide tube 1 guides and feeds the endoscope 2 through the oral cavity (not shown) and the stomach 80 and into the fermenter papilla 83a in the duodenum 81. That is, the procedure using the guide tube 1 of the present embodiment is to insert the endoscope 2 which is a transnasal endoscope orally into the body cavity of the subject together with the guide tube 1.
The guide tube 1 includes a main lumen 20 communicating in the axial direction at the center, and is configured so that the endoscope 2 with a camera 2b (see FIG. 11) can be inserted therein.

The guide tube 1 has a flexible tube body 3 having a bent portion 3a on the distal end side, a bending operation portion 4 which is provided at a proximal end portion of the tube main body 3 and bends the bent portion 3a, and is described later. Is provided. The tube body 3 is formed with an opening 3b (see FIG. 3) that communicates with the outside on the distal end side of the bending start portion, which will be described later, of the bending portion 3a and on the extension of the main lumen 20 in the axial direction. ing.
The guide tube 1 includes a bent portion 3 a described below at the distal end portion of the tube body 3. Furthermore, the guide tube 1 includes the bending operation portion 4 on the proximal end side of the tube body 3, thereby bending the bending portion 3 a toward the furter papilla 83 a, so that the endoscope 2 can be moved from the opening 3 b of the tube body 3. It is configured to be able to project and feed into the ferrer teat 83a.

<About the tube body>
The tube body 3 is mainly composed of a flexible resin member made of nylon, nylon elastomer, polyurethane, or the like, and a reinforcing member such as a coiled metal reinforcing wire 32 or holding wire 70. . The reinforcing member may be braided in a mesh shape or may be a highly rigid resin material.
The tube body 3 is a hollow tubular and long member having a main lumen 20 formed therein, and an inner layer 24 defining the main lumen 20, a wire reinforcing layer 30, an operation line 60 and the like are arranged. An outer layer 50.

  The inner layer 24 determines the main lumen 20 by its inner wall surface. The wall surface of the main lumen 20 is provided with a hydrophilic lubricious coating for making the endoscope 2 easy to slide and making the relative movement with respect to the guide tube 1 easy. A method of supplying the lubricant according to this coating will be described later.

  The wire reinforcement layer 30 is a protective layer that is provided on the inner diameter side of the operation line 60 in the tube body 3 and protects the inner layer 24. The presence of the wire reinforcing layer 30 on the inner diameter side of the operation line 60 can prevent the operation line 60 from penetrating from the outer layer 50 to the inner layer 24 and being exposed to the main lumen 20. The wire reinforcing layer 30 is formed by winding a reinforcing wire 32. As the material of the reinforcing wire 32, a resin material having a shear strength higher than that of the inner layer 24 and the outer layer 50 can be used in addition to the metal material.

  In the outer layer 50, two sub tubes 40 for disposing the two operation lines 60 in the tube body 3 so as to be movable, and a holding wire 70 are embedded, and an outer side for expanding the balloon 10 described later. A lumen 10a is formed.

As shown in FIG. 4, the two sub-tubes 40 are arranged at positions that oppose each other by 180 degrees around the axis of the tube body 3. The two subtubes 40 extend in parallel to the axial direction of the tube body 3. As will be described later, three or four sub tubes 40 may be arranged around the axis of the tube body 3 at equal intervals.
As shown in FIG. 3, an operation line 60 to be described later is slidably inserted in a sub lumen 42 that is a hollow space of the sub tube 40.

The holding wire 70 of the present embodiment is a coil, and more specifically, a coil (multiple coil) in which a plurality of strands are wound in multiple lines.
The holding wire 70 is wound in a spiral shape so as to surround the outside of the pair of subtubes 40 that are arranged to face each other around the main lumen 20. The winding shape of the holding wire 70 of the present embodiment is a substantially elliptical shape or a substantially rhombic shape in which the arrangement direction of the subtubes 40 is the major axis direction. In FIG. 4, the holding wire 70 whose winding shape forms a substantially rhombus is shown by a broken line. The holding wire 70 is in contact with the peripheral surface of the sub-tube 40, specifically, the outer surface that is opposite to the axis of the main lumen 20.
Since the holding wire 70 is disposed, the tube main body 3 has rigidity while having flexibility, so that kink can be prevented.

The tube body 3 has a function of suppressing a surgical invasion when the guide tube 1 is inserted into the body, and includes a soft protective member (hood 5) at the tip. The hood 5 is made of a soft resin such as polyvinyl chloride, which is softer than the tube body 3.
The hood 5 is attached to the distal end of the tube body 3 and has an opening 5a that communicates the main lumen 20 of the tube body 3 with the outside. By forming the opening 5 a in the hood 5 in this way, the endoscope 2 passing through the main lumen 20 can be projected to the outside through the opening 5 a of the hood 5.
The endoscope 2 is inserted through the opening 5a into the bile duct 83 through the opening 5a in a state in which the hood 5 is disposed so as to surround the periphery of the fetal nipple 83a and abut against the inner wall of the duodenum 81.
Note that the hood 5 according to this embodiment is described as an example of a member that is a separate member from the tube main body 3. However, if the hood 5 is made of a soft resin and can suppress surgical invasion, the hood 5 is integrated with the tube main body 3. It may be formed.

<About the function and structure of the bent part>
Next, the function / structure of the bent portion 3a will be described.
The guide tube 1 includes two operation lines 60 that pass through the inside of the tube main body 3 (strictly speaking, in the auxiliary lumen 42 formed inside the tube main body 3).
The operation line 60 is made of a metal wire, and the proximal end of the operation line 60 is connected to the bending operation unit 4 described later, and the distal end of the operation line 60 is the distal end side of the tube body 3 (particularly, the bending unit 3a). It is fixed to the ring 14 embedded in by soldering. The mode of fixing the operation line 60 to the ring 14 is not particularly limited, and may be fixed by soldering, heat fusion, adhesion with an adhesive, mechanical engagement between the operation line 60 and the ring 14, or the like. .
The operation wire 60 may be formed of a single wire, but may be a stranded wire formed by twisting a plurality of thin wires. The number of fine wires constituting one stranded wire of the operation wire 60 is not particularly limited, but is preferably 3 or more. The operation line 60 of this embodiment is a stranded wire in which seven strands are twisted together.

  As the operation wire 60, low carbon steel (piano wire), stainless steel (SUS), a steel wire coated with corrosion resistance, titanium or a titanium alloy, or a metal wire such as tungsten can be used. In addition, the operation line 60 includes polyvinylidene fluoride (PVDF), high density polyethylene (HDPE), poly (paraphenylenebenzobisoxazole) (PBO), polyetheretherketone (PEEK), polyphenylene sulfide (PPS), Polymer fibers such as polybutylene terephthalate (PBT), polyimide (PI), polytetrafluoroethylene (PTFE), or boron fiber can be used.

As shown in FIG. 3, the bent portion 3 a is located at a portion from the non-formation region of the wire reinforcing layer 30 in which the bending rigidity is lowered to the tip of the tube body 3 because the reinforcing wire 32 in the tube body 3 is not disposed. is there.
The bending part which concerns on this invention should just have bending rigidity low compared with the part which is not a bending part. Therefore, the reinforcing wire 32 according to the present embodiment is not limited to the one in which the bending rigidity is lowered by the absence of the reinforcing wire 32. For example, the tube body 3 is made of a different material, and the bending rigidity of the material on the distal end side of the tube body 3 is lower than the bending rigidity of the material on the proximal end side. May constitute a bent portion.
Moreover, the base end part of the non-formation area | region of the wire reinforcement layer 30 in the front end side of the tube main body 3 is equivalent to the bending origin part which concerns on embodiment of this invention. Similarly in this respect, when the bent portion is configured by the difference in bending rigidity of the material, the base end portion of the material having low bending rigidity corresponds to the bending start point.

The bending portion 3a is bent with respect to the proximal end portion of the tube body 3 as shown in FIG. 2 when the operation line 60 is drawn (pulled) by the bending operation portion 4 described later. Specifically, the bending portion 3a bends when a tensile force due to the operation line 60 being drawn is applied to the ring 14 on the distal end side of the bending portion 3a that does not overlap the axis of the tube body 3. It becomes.
The practitioner can bend the guide tube 1 passing through the duodenum 81 toward the furter papilla 83a by guiding the endoscope 2 by operating the bending operation unit 4 described later.

<About the structure of the bending operation section>
Next, the structure of the bending operation part 4 that operates the bending state of the bending part 3a will be described with reference mainly to FIGS. FIG. 5 is an explanatory view schematically showing the inside of the bending operation section 4, FIG. 6 is a view showing the inside of the bending operation section 4, VI-VI sectional view of FIG. 5, and FIG. It is a perspective view shown.

  The bending operation unit 4 rotates the action drum 15 that applies a tensile force to the two operation lines 60, the angle holding part 4A that can hold the bending part 3a stepwise at a plurality of bending angles, and the action drum 15. The operation knob 92 is mainly composed of a housing 18 and a housing lid 19.

The housing 18 includes an intermediate plate 18a formed in the vicinity of the center in the vertical direction that divides the upper space and the lower space. The guide tube 1 is passed through the lower space of the housing 18, and the working drum 15, the angle holding portion 4 </ b> A, and a part of the operation knob 92 are disposed in the upper space. The middle plate 18a is formed with a through hole 18c that allows the operation line 60 to pass through the upper and lower spaces.
Further, an insertion hole 18b for inserting a stopper 27 described later from the outside is formed in the housing 18 in the vicinity of the engaging member 25.
The housing lid 19 covers the open portion of the space above the housing 18 from above, and supports the operation knob 92 in a rotatable manner.

  The action drum 15 is a part that pulls the engagement end 60 a of the operation line 60, and two insertion holes 15 a are formed in parallel through a virtual plane parallel to the axial direction of the guide tube 1. Yes.

  The operation knob 92 includes a round bar-like fitting portion 92a that is fitted to the upper portion of a gear portion 16 to be described later and transmits rotational torque. Similarly, the lower portion of the gear portion 16 is fitted to the upper portion of the working drum 15 to transmit the rotational torque. With such a configuration, when the practitioner rotates the operation knob 92, the gear portion 16 and the action drum 15 fitted to the fitting portion 92a are rotated.

On both side surfaces of the guide tube 1, extraction holes 50 a through which the operation line 60 can be drawn from the inside to the outside are formed.
The two operation lines 60 are respectively drawn from the inside of the two sub tubes 40 through the drawing holes 50a, and are passed from the lower space to the upper space through the through holes 18c. The two operation lines 60 are passed through the insertion hole 15 a of the action drum 15. Engagement end portions 60 a are formed at the base end portions of the two operation lines 60. The engagement end portion 60a is disposed so as to be engageable with the action end edge 15b on the base end side of the insertion hole 15a according to the rotating state of the action drum.

  When the action drum 15 is turned by the turning operation of the operation knob 92, the action end edge 15b comes into contact with one engagement end portion 60a of the two operation lines 60 and is pulled to the base end side. A tension is applied to one operation line 60. At this time, since the working edge 15b is separated from the other engagement end 60a, no tension is generated in the other operation line 60. One operation line 60 pulled from the engaging end 60a by the action end edge 15b bends the bent portion 3a at the tip of the guide tube 1 by its tension.

<About the angle holder>
The angle holding portion 4 </ b> A includes a gear portion 16, an engagement member 25, and a spring 26.
The gear portion 16 includes a plurality of teeth 16a protruding outward in the radial direction on the outer periphery thereof.
The engaging member 25 includes three engaging teeth 25a that can engage with the teeth 16a of the gear portion 16 in a position facing the teeth 16a in the present embodiment. The engaging member 25 is urged by a spring 26 in a direction from the base end side toward the gear portion 16. The engaging member 25 and the gear portion 16 are disposed at positions where the engaging teeth 25a of the engaging member 25 and the teeth 16a of the gear portion 16 are engaged when the spring 26 is in a natural state.

When the practitioner rotates the operation knob 92, the angle holding part 4A configured in this way resists the biasing force of the spring 26 so that the teeth 16a push the engaging teeth 25a toward the proximal end side. The engaging member 25 is moved in the direction of the two-dot chain line shown in FIG. At this time, one of the two operation lines 60 comes into contact with the action end edge 15b and is pulled by the action drum 15, whereby the bent portion 3a is bent in one direction.
Then, when the groove portion between the adjacent teeth 16a moves to a portion of the engaging member 25 facing the engaging teeth 25a, the engaging member 25 is moved based on the restoring force of the spring 26 to be engaged. The teeth 25a and the teeth 16a mesh with each other and the state is temporarily maintained. That is, the bent portion 3a is kept bent by a predetermined angle.
Further, if the practitioner rotates the operation knob 92 so that a force equal to or greater than the urging force of the spring 26 is applied, the engaging member 25 is moved and the bent portion 3a is bent by a predetermined amount as described above. It becomes.

  As described above, the angle holding portion 4A can adjust the bending angle of the bending portion 3a step by step so that the angle of the furter papilla 83a is located on the extension of the opening 3b. Therefore, the practitioner can hold the bent portion 3a at a desired angle, and can easily project the endoscope 2 from the guide tube 1 toward the furter papilla 83a, and can easily access the puffer papilla 83a. It becomes.

Further, the bending operation section 4 is provided with a bending fixing section (stopper 27) for fixing the bending angle of the bending section 3a shown in FIGS.
The stopper 27 is a plate piece having a linear groove 27a and formed in a U shape. The stopper 27 is inserted into the housing 18 from the insertion hole 18b formed in the housing 18 so that the engagement state between the engagement teeth 25a and the teeth 16a is maintained. Restrict movement. The groove 27a is for avoiding interference between the stopper 27 and the spring 26 when the stopper 27 is inserted into the housing 18 from the insertion hole 18b.
The position where the stopper 27 is inserted prevents the engagement member 25 from retracting from the gear portion 16 while maintaining the engagement state between the teeth 16a and the engagement teeth 25a while accommodating the spring 26 in the groove 27a. Position. That is, the insertion hole 18b into which the stopper 27 is inserted is formed at this position.

The practitioner inserts the endoscope 2 into the fater papilla 83a by inserting the stopper 27 into the insertion hole 18b of the housing 18, fixing the engaging member 25, and fixing the bending angle of the bending portion 3a. Work becomes easy.
In addition, although the bending fixing part (stopper 27) of this embodiment restrict | limits the rotation of the gear part 16 by restrict | limiting the movement of the engaging member 25, it seems to engage with the gear part 16 directly. Then, the rotation may be limited.
The stopper 27 is not necessarily required if the bent portion 3a can be sufficiently held by the angle holding portion 4A.
Further, as the bending fixing portion, it is only necessary that a part of the operation line 60 can be fixed relative to the tube body 3 so that the movement of the operation line 60 can be restricted. It is not limited to.

<About balloon>
Next, in addition to FIG. 3, the balloon 10 will be described mainly with reference to FIGS. 8 is a cross-sectional view of the guide tube 1 in the vicinity of the balloon 10, and is a cross-sectional view taken along the line VIII-VIII in FIG. 3. FIG. 9 is a partial cross-sectional view showing the deaeration prevention valve 6, the clamp 7 and the lumen connecting portion 8. is there.

A balloon 10 that extends radially outward of the guide tube 1 is attached to the tube body 3, and a flow path (outer lumen 10 a) for feeding liquid (distilled water 10 b) or gas into the balloon 10 is formed. ing.
The balloon 10 has a function of fastening the guide tube 1 at a predetermined position in the body cavity (in the present embodiment, the duodenum 81) by expanding.

As shown in FIG. 9, the proximal end portion of the outer lumen 10a is connected to a syringe connecting portion 11 for connecting to a syringe (not shown) provided in the lumen connecting portion 8 via a connecting tube 11a. Distilled water 10b is pushed from a plunger (not shown) and filled into the balloon 10 via the syringe connecting portion 11 and the outer lumen 10a, whereby the balloon 10 is expanded.
Also, as shown in FIG. 3, the balloon 10 is disposed away from the bent portion 3a toward the proximal end side so as not to affect the bending operation of the bent portion 3a.
As described above, the bent portion 3a is bent at a portion where the bending rigidity is lowered because the reinforcing wire 32 is not disposed.
In the present embodiment, the boundary between the portion where the reinforcing wire 32 is not disposed and the portion where the reinforcing wire 32 is disposed is the most proximal position that is the proximal end of the bending portion 3a. For this reason, the balloon 10 is arranged so that the distal end of the balloon 10 is located on the proximal side of the boundary position so as not to affect the bending operation of the bending portion 3a.

As described above, the balloon 10 is attached to the tube main body 3, and a flow path (outer lumen 10 a) for feeding liquid or gas into the balloon 10 is formed. For this reason, the balloon 10 can be expanded and the guide tube 1 can be fixed at a predetermined position, and the endoscope 2 can be stably fed into the furter papilla 83a.
Specifically, when the endoscope 2 is inserted into the body by the frictional force caused by the contact between the inner surface of the guide tube 1 and the outer surface of the endoscope 2, The guide tube 1 is about to move. In this regard, the balloon 10 is expanded and pressed against the inner wall of the duodenum 81, so that the guide tube 1 can be held at a predetermined position of the duodenum 81. Therefore, the balloon 10 can prevent the guide tube 1 from moving along with the endoscope 2, and the endoscope 2 can easily protrude from the guide tube 1.
As long as the balloon 10 can be expanded and contracted, the fluid filled in the balloon 10 is not limited and is not limited to the distilled water 10b, but may be other liquids or gases.

<About Lumen for Lubricant>
Next, the lubricant lumen will be described with reference mainly to FIG. 10 in addition to FIG. 3 and FIG. 9.
In the tube body 3, in addition to the main lumen 20 through which the endoscope 2 passes, a sub-lumen (inner lumen 21) communicating with the main lumen 20 is formed in the tube body 3.
The inner lumen 21 has a function of introducing a lubricant into the main lumen 20 through the plurality of openings 21a.
As shown in FIG. 9, the proximal end portion of the inner lumen 21 is connected to a syringe connecting portion 12 for connecting to a syringe (not shown) provided in the lumen connecting portion 8 via a connecting tube 12a. A lubricant (not shown) is pushed from a plunger (not shown) and is supplied into the main lumen 20 via the syringe connecting portion 12 and the inner lumen 21.
In this way, the sub-lumen (inner lumen 21) communicating with the main lumen 20 is formed in the tube body 3, so that the lubricant can be supplied to the main lumen 20 via the sub-lumen (inner lumen 21). It becomes possible. With the lubricant supplied into the main lumen 20, the endoscope 2 can be smoothly moved relative to the guide tube 1 when the endoscope 2 is fed into the furter papilla 83 a.
In particular, at least a part of the opening 21 a is formed at a position corresponding to the bent portion 3 a in the main lumen 20. When the tube body 3 is bent, the endoscope 2 is likely to come into contact with the bent portion 3a. Thus, the endoscope 2 is more smoothly projected from the tube body 3 by supplying the lubricant from the inner lumen 21 through the opening 21a into the main lumen 20 at the position of the bent portion 3a. Is possible.
Further, the number of openings 21a may be more than just the number shown in FIG.

  Note that the timing of supplying the lubricant into the main lumen 20 is not limited to when the endoscope 2 is projected from the guide tube 1 toward the furter teat 83a. For example, a lubricant may be supplied into the main lumen 20 when the guide tube 1 and the endoscope 2 are inserted into the body. If it does in this way, when inserting guide tube 1 and endoscope 2 into a body, it can control that guide tube 1 and endoscope 2 interfere with each other.

<Endoscope fixation>
Next, a clamp 7 for locking and unlocking the guide tube 1 and the endoscope 2 will be described with reference mainly to FIG. 11 in addition to FIG. FIG. 11 is a perspective view showing a state in which the distal end portion of the endoscope 2 is protruded from the guide tube 1.
The guide tube 1 itself does not include a camera. For this reason, if only the guide tube 1 alone is inserted into the body, the tip position of the guide tube 1 cannot be grasped, and it is difficult to suppress the surgical invasion, for example, contact with the inner wall of the stomach 80 or the duodenum 81. The guide tube 1 according to the present embodiment is not inserted into the body as a single unit, but with the endoscope 2 attached to the guide tube 1 using the camera 2b provided on the endoscope 2 To be inserted.

The guide tube 1 includes a lock mechanism (clamp 7) that locks and unlocks the endoscope 2 so that the state in which the camera 2b is disposed in the vicinity of the distal end of the guide tube 1 can be maintained.
The lock mechanism (clamp 7) is provided so that it can be locked in a state where the camera 2b is exposed from the guide tube 1. Specifically, the clamp 7 is mainly composed of a pair of parts formed in an arc shape, and the pair of parts are connected so as to form a virtual circle. The pair has a pair of opposed end pieces 7a, and a hexagon screw 7b is passed through the pair of end pieces 7a. A female screw hole is formed in one of the pair of end pieces 7a.
When the hexagonal screw 7b is tightened, the pair of end pieces 7a approach each other, so that the diameter of the clamp 7 is narrowed, and the guide tube 1 is deformed by applying a load in the center direction. Therefore, the endoscope 2 can be locked.
On the contrary, if the hexagon screw 7b is loosened, the pair of end pieces 7a are separated from each other so that the diameter of the clamp 7 is widened, the load in the center direction on the guide tube 1 is weakened, and the lock on the endoscope 2 is released. The Rukoto.

Further, the state in which the camera 2b is exposed from the guide tube 1 is not limited to the state in which the camera 2b is completely exposed to the outside of the guide tube 1. A state in which the outside of the guide tube 1 can be projected, for example, a state in which the camera 2b is positioned in the guide tube 1 and a state in which the outside can be projected from the opening 3b of the guide tube 1 is included. .
The guide tube 1 can be inserted into the body with the guide tube 1 and the endoscope 2 locked. For this reason, the guide tube 1 and the endoscope 2 can be inserted into the body while confirming the insertion positions of the guide tube 1 and the endoscope 2 by the camera 2b of the endoscope 2.
As a specific treatment method, the bending portion 3a is bent by the bending operation portion 4 when the furter papilla 83a enters the visual field of the camera 2b. Further, the lock by the clamp 7 is released, and the endoscope 2 is protruded from the guide tube 1 and fed into the furter papilla 83a.

<About deaeration prevention valve>
A deaeration prevention valve 6 is provided on the proximal end side of the tube body 3 as shown in FIG.
The deaeration prevention valve 6 prevents gas flow from the distal end to the proximal end of the tube main body 3, and includes a substantially cylindrical main body 6a and a sealing film 6b attached to the inner surface of the main body 6a. Prepare.
The sealing film 6b has a hole penetrating in the thickness direction at the radial center, and is formed so as to swell toward the distal end side and the proximal end side in the radial direction. It is formed to have elasticity in the direction.
The deaeration prevention valve 6 formed in this way is passed through the hole of the sealing film 6b through the guide tube 1 and the side surface of the base end portion of the guide tube 1 is along the inner surface of the main body 6a. The guide tube 1 is attached so as to be in contact with the distal end surface. The deaeration prevention valve 6 attached in this way can seal the space between the guide tube 1 and the tube body 3. According to the deaeration prevention valve 6, even if a gap is generated between the guide tube 1 and the deaeration prevention valve 6, the gas introduced into the stomach 80, the duodenum 81, and the like is deaerated from this gap. Can be prevented. For this reason, the internal organs such as the stomach 80 can be held in a state inflated with gas, and the guide tube 1 can be easily inserted into the internal organs.

  Further, a mouthpiece 9 is attached to the distal end side of the guide tube 1 with respect to the bending operation portion 4 so as to be easily inserted into the human oral cavity and allow the guide tube 1 to pass through. The mouthpiece 9 can prevent gas leakage from the outside of the guide tube 1.

(First modification)
The guide tube 1 according to the above-described embodiment has been described as including the operation line 60 disposed at a position opposed to 180 degrees around the axis of the tube body 3 and the sub-tube 40 into which the operation line 60 is loosely inserted. However, the present invention is not limited to such a configuration, and like the guide tube 1X shown in FIG. 12, the operation line 60 and the loose insertion are inserted at positions facing each other by 90 degrees around the axis of the tube body 3. The subtube 40 may be provided. FIG. 12 is a cross-sectional view of the guide tube 1X according to the first modification.
According to the guide tube 1X having such a configuration, the flexibility of the bending portion 3a in the bending direction can be further increased, and the operability of the guide tube 1X can be increased. The bending operation part in this case may be a spherical one.

(Second modification)
The guide tube 1 according to the above embodiment has been described on the assumption that the opening 3b of the main lumen 20 is formed in the axial direction of the guide tube 1 and the endoscope 2 protrudes from the opening 3b. However, the present invention is not limited to such a configuration, and a horizontal hole 1Ya perpendicular to the axial direction of the guide tube 1Y is formed like the guide tube 1Y shown in FIG. The structure which protrudes the endoscope 2 may be sufficient. FIG. 13 is a longitudinal sectional view schematically showing a guide tube 1Y according to a second modification.
According to the guide tube 1 </ b> Y having such a configuration, even if the bending by the bending portion 3 a is small, it is possible to easily access the fermenter papilla 83 a on the wall surface of the duodenum 81. Further, depending on the arrangement relationship between the guide tube 1Y and the furter nipple 83a, the endoscope 2 can be inserted into the furter nipple 83a without bending the bending portion 3a.

The above embodiment includes the following technical idea.
(1) A guide tube through which an endoscope with a camera can be inserted,
The guide tube is for feeding the endoscope into the papilla in the duodenum,
A tube body having a bending portion on the tip side and having flexibility, and
A bending operation portion provided at a proximal end portion of the tube main body and bending the bending portion;
In the tube body, an opening is formed on the tip side of the bending start point of the bent part,
A guide tube configured to be able to project the endoscope from the opening of the tube main body with the bent portion bent toward the furter papilla and feed the tube into the fatter papilla.
(2) Connected to the bending operation part, comprising an operation line passing through the inside of the tube body,
The distal end of the operation line is fixed to the distal end side of the bent portion,
The guide tube according to (1), wherein the bent portion is bent when the operation line is drawn by operation of the bending operation portion.
(3) It further comprises a lock mechanism for locking and unlocking the endoscope,
The locking mechanism according to (1) or (2), wherein the locking mechanism is provided so as to be lockable in a state where the camera is exposed from the guide tube.
(4) A balloon that expands radially outward of the guide tube is attached to the tube body, and a flow path for feeding liquid or gas into the balloon is formed (1) to (3 ) The guide tube according to any one of the above.
(5) In addition to the main lumen through which the endoscope is passed, the tube main body is formed with a sub-lumen communicating with the main lumen in the tube main body. Guide tube as described in.
(6) The guide tube according to any one of (1) to (5), wherein the bending operation unit further includes an angle holding unit capable of holding the bending portion in a stepwise manner at a plurality of bending angles.
(7) The guide tube according to any one of (1) to (6), further including a bending fixing portion that fixes a bending angle of the bending portion.
(8) On the proximal end side of the tube body, a deaeration prevention valve is provided,
The deaeration prevention valve is the guide tube according to any one of (1) to (7), which prevents a gas flow from the distal end to the proximal end of the tube main body.
(9) The guide tube according to any one of (1) to (8), wherein the tube main body includes a soft protective member at a distal end portion.

1, 1X, 1Y Guide tube 1Ya Side hole 2 Endoscope (Endoscope with camera)
2a Operation part 2b Camera 2c Light 3 Tube body 3a Bending part 3b Opening part 4 Bending operation part 4A Angle holding part 5 Hood (protective member)
5a Opening 6 Deaeration prevention valve 6a Main body 6b Sealing film 7 Clamp (lock mechanism)
7a End piece 7b Hex screw 8 Lumen connection part 9 Mouthpiece 10 Balloon 10a Outer lumen (flow path)
10b Distilled water 11, 12 Syringe connection part 11a, 12a Connecting tube 14 Ring 15 Working drum 15a Insertion hole 15b Working edge 16 Gear part (Angle holding part)
16a tooth 18 housing 18a middle plate 18b insertion hole 18c through hole 19 housing lid 20 main lumen 21 inner lumen (sub-lumen)
21a Opening 24 Inner layer 25 Engaging member (angle holding part)
25a Engagement tooth 26 Spring 27 Stopper (flexion fixing part)
27a Groove 30 Wire reinforcing layer 32 Reinforcing wire 40 Subtube 42 Sublumen 50 Outer layer 50a Extraction hole 60 Operation line 60a Engaging end 70 Holding wire 80 Stomach 81 Duodenum 82 Pancreas 83 Bile duct 83a Fater nipple 92 Operation knob 92a Fitting part

Claims (9)

A guide tube through which an endoscope with a camera can be inserted,
The guide tube is for feeding the endoscope into the papilla in the duodenum,
A tube body having a bending portion on the tip side and having flexibility, and
A bending operation portion provided at a proximal end portion of the tube main body and bending the bending portion;
In the tube body, an opening is formed on the tip side of the bending start point of the bent part,
A guide tube configured to be able to project the endoscope from the opening of the tube main body with the bent portion bent toward the furter papilla and feed the tube into the fatter papilla. Connected to the bending operation part, comprising an operation line passing through the inside of the tube body,
The distal end of the operation line is fixed to the distal end side of the bent portion,
The guide tube according to claim 1, wherein the bending portion is bent when the operation line is drawn by an operation of the bending operation portion. A lock mechanism for locking and unlocking the endoscope;
3. The guide tube according to claim 1, wherein the lock mechanism is provided so as to be locked in a state where the camera is exposed from the guide tube.   A balloon that expands radially outward of the guide tube is attached to the tube body, and a flow path for feeding liquid or gas into the balloon is formed. The guide tube according to the item.   The guide tube according to any one of claims 1 to 4, wherein a sub-lumen communicating with the main lumen is formed in the tube main body in addition to the main lumen through which the endoscope passes. .   The guide tube according to any one of claims 1 to 5, wherein the bending operation unit further includes an angle holding unit capable of holding the bending portion in a stepwise manner at a plurality of bending angles.   The guide tube according to any one of claims 1 to 6, further comprising a bending fixing portion that fixes a bending angle of the bending portion. On the proximal end side of the tube body, a deaeration prevention valve is provided,
The guide tube according to any one of claims 1 to 7, wherein the deaeration prevention valve prevents a gas flow from a distal end to a proximal end of the tube main body.   The guide tube according to any one of claims 1 to 8, wherein the tube main body includes a soft protective member at a distal end portion.

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